Shoulder Bursitis Pain
Bursa are unique little pouches of fluid-filled tissue that exist between structures in the body that often come into contact with each other – usually between muscles, muscles and bones, bones and joints etc. They are there to reduce the friction that occurs during everyday movement, for example: Painting, plastering, weight lifting – basically anything that is a reoccurring activity performed over and over again. When a bursa becomes inflamed and painful, the medical term used to describe this is bursitis. Bursitis can happen to any bursa in the body, however it is very common in the shoulder and something we see in our clinic weekly. The term you may hear from your Physio or Doctor is – subacromial bursitis.
Symptoms of Subacromial Bursitis
- Sudden sharp pain that may occur during overhead activities, then persists “burning” or sharp pain thereafter
- Tenderness around the AC joint (where the collarbone and shoulder meet)
- Weakness of the shoulder
- Mild swelling around the shoulder
Will Injection Help?
This is a loaded questions – it depends!
A subacromial bursa injection (often a corticosteroid injection) aims to introduce a powerful anti-inflammatory substance into the inflamed bursa. A local anaesthetic substance may also be used to complement this – especially if your pain is quite severe. This can relieve the shoulder of pain in the short term. However, subacromial bursitis can often be caused by faulty shoulder biomechanics – most often with the rotator cuff muscle group. During shoulder movements, the rotator cuff muscle group is responsible for stabilising the top of the arm-bone (the “ball” in the ball and socket joint) within the socket. If this doesn’t happen effectively, an impingement within the shoulder joint can occur. This impingement very commonly upsets the bursa, resulting in subacromial bursitis.
If an injection is performed when the issue has originated from poor shoulder biomechanics, it is likely the impingement will continue during everyday movements – it just won’t be painful. Although further inflammation and pain may be dampened by the substances injected into the bursa, once the effects of the injection wear off (after a few weeks/months) the pain is likely to return as the original cause (poor biomechanics) has not been addressed.
If you have ever had your mouth numbed during a dental procedure and then bitten your cheek/lip, you may have been surprised to not feel any pain at all. However later that day as the anaesthetic wears off you probably found you have a sore mouth especially right where you bit it. This is no different to allowing a shoulder impingement to persist – the main difference is that you are likely to be numbed from the shoulder pain for a period of weeks/months, rather than just a few hours.
How can Trained Physio help?
The role of physiotherapy when it comes to shoulder pain (whether or not its pertaining to a subacromial bursitis) is to analyse and assess which biomechanical factors may be contributing to the pain. Shoulder impingement can be due to a weak rotator cuff, injured/tendinopathic rotator cuff, poor activation of the shoulder stabilisers or tight or spasmed chest/neck/back muscles – to name a few.
Your Trained Physio can also help rule out any other conditions that can present similarly to subacromial bursitis. These include (but are not limited to) rotator cuff tendinopathy, frozen shoulder / adhesive capsulitis, AC-joint sprain, nerve pain/impingement, biceps tendinopathy/tear, and shoulder arthritis.
If conservative intervention (manual therapy, exercise therapy etc) does not provide any benefit after a few weeks, your Physio may suggest a bursal injection to help with short-term pain. This can provide a window of a few weeks/months where the cause of the impingement can carry out rehabilitation without any pain, with the ideal outcome being return of pain-free function once the injection wears off.
How long will it take to recover?
The timeline for recovery from subacromial bursitis varies greatly, but a general rule of thumb is that the longer it has been an issue, the longer it may take to recover. An accurate prognosis can be given when the factor/s causing the subacromial bursitis have been examined and evaluated by a qualified Physiotherapist.
Most clients we see with subacromial bursitis gain anywhere from a small to very-large improvement after a few sessions of manual therapy (soft tissue release, joint mobilisation etc). This is often combined with exercise therapy aimed at fixing any contributing biomechanical factors to alleviate the impingement and reduce inflammation of the bursa.
As a ball-park figure, most people who present with recent-onset subacromial bursitis with low-to-moderate pain levels notice an improvement within 4-6 weeks of physiotherapy treatment. If there is little-to-no improvement within this time period then further intervention may be necessary (medical modalities such as an injection as mentioned above or oral painkillers/anti-inflammatories). If managed appropriately your pain should be under control by the 3-6 month mark, although sometimes low levels of pain during niche activities can persist beyond 6-months especially if your initial pain levels were severe.
What you can expect from Trained Physio:
- Thorough assessment and treatment of your injury
- Comprehensive exercise rehab from the date of your injury, through to your return to full activity
- Assessment into why the injury occurred in the first place, and what can be done to keep you injury-free
- Manual therapy, dry needling and other treatment-specific techniques as needed
- Training modifications to keep you as active as possible whilst undergoing rehab (if necessary)
- Use of our fully equipped rehabilitation facility for exercise rehab
Our East Perth Trained Physio’s can provide a thorough assessment of your current and previous training, taking into account all lifestyle factors that may be adding to your injury or pain state. A full body assessment will identify any weakness, imbalances or loading issues which may be impacting your training. Physiotherapy has several goals including promote healing, reduce pain, avoiding aggravation, optimising physical function and global strengthening to restore normal movement patterns. To see how we can help you BOOK ONLINE TODAY
BSc. Physiotherapy (Curtin)
ASCA Strength & Conditioning Coach (Level 1)